HISTORY: During a race, a 35-year-old marathon runner complained of experiencing dull, achy pain in the right groin. After the race, he occasionally experienced radiating pain in the right thigh. The athlete was examined by a general practitioner (GP). During the clinical evaluation, the athlete had no signs of tenderness or swelling. The GP suggested rest and prescribed anti-inflammatory medication.
PHYSICAL EXAMINATION: Ten days later, during training, the athlete felt the same discomfort after a challenging training session. He, then, decided to see an orthopedic physician. At the clinical examination, there was no localized pain. Focal pain was present during weight bearing activities only. Initial x-rays showed no significant abnormality or fracture. However, due to the complaints of the athlete, the doctor suggested additional x-rays and an MRI.
- Lumbar radiculopathy
- Rectus femoris strain
- Abductor strain
- Trochanteric bursitis
TEST AND RESULTS:
- X-ray showed a fracture of the middle shaft of the femur
- MRI showed a medial periosteal reaction in the femoral shaft (high fluid signal)
- Pain, especially during internal rotation
- Pain on the affected side with a single-leg stance
- Pain during activity, reproducible on passive range of motion
FINAL / WORKING DIAGNOSIS:
Stress fracture of the middle shaft of the right femur
TREATMENT AND OUTCOMES:
- Tolerate weight bearing if no displacement occurs (four months max.)
- Treatment by a metabolic physician (Vitamin D deficiency or other)
- Continuing follow-up with repeated imaging: Verify resolution and minimize the progression to displacement
- Surgery if conservative management fails (see #1-3)
- Intramedullary rodding (surgical procedure)
Siddiq, Bill; Gravvanis, Nikolaos; Vicencio, Lisa A.; and Stamatis, Andreas
"Femur Stress Fracture - Marathon,"
International Journal of Exercise Science: Conference Proceedings: Vol. 15:
1, Article 16.
Available at: https://digitalcommons.wku.edu/ijesab/vol15/iss1/16